dr. christie ganas m.d. penn state health st. joseph
TRANSCRIPT
Young SurvivorsSexuality and Fertility
Dr. Christie Ganas M.D.Penn State Health St. Joseph
Difficult topic
Uncomfortable to talk about◦patient and partner◦Health care provider
Taboo subject Myths about sex Significant impact on quality of life Barriers
Difficult topic to discuss
OrgasmArousalDesire
What is normal??
Normal Sexual Response
Emotional intimacy
Sexual stimuli
Sexual arousal
Arousal and sexual
desire
Emotional and
physical satisfactio
n
Intimacy-Based Model
Factors Affecting Sexual Function
Medical history, illness, medications,
hormones
Family, cultural, society
Partner relationship, sexual image,
sexual experience
External stressors,
Psychological well-being
Surgery Chemotherapy Radiation Anti-hormonal Medications
Body Changes and Cancer Treatment
Body Image Depression Anxiety Fear Guilt Partner’s fears/concerns
Psychological Effects
Poor vs good emotional well-being Presence or absence of vaginal dryness Quality of the partnered relationship
Predictors of Sexual Health after Cancer Diagnosis
Vaginal dryness Arousal Desire Orgasm
Issues
Lubricants and moisturizers◦ Lubricants are a temporary measure to relieve
vaginal dryness during intercourse◦ Water oil silicone based◦ Moisturizers provide long-term relief of vaginal
dryness ?? Role of local estrogen- discussion with
oncologist and gynecologist◦ Personalized and individualized plan◦ Risk of recurrence????
Vaginal Dryness
Vibrators Dilator therapy Pelvic floor physical therapy Eros clitoral therapy device
Arousal
Lifestyle modification Exercise Nutrition Social support Stress, Time, Life management
Behavior modification
Get comfortable with scars, changes Look, touch New normal Communicate with partner Setting the scene
Prepare
Make it a priority Start gradually Ways to feel less self-conscious Setting the scene Goal is pleasure -not performance
Reduce anxiety
Hugging Fondling Caressing Cuddling Kissing Hand holding Manual/oral stimulation Intra thigh or intra mammary intercourse
Alternative forms of physical love
Flibanserin- nonhormonal therapy that works on key sexual pathways in the brain◦ FDA approval ◦ Efficacy on desire and satisfying sexual evidence
Bupropion -effects norepinephrine and dopamine uptake◦ Increase sexual responsiveness and orgasmic
activity Sildenafil – used to treat antidepressant
associated sexual dysfunction, not FDA approved
Medication
Condoms Diaphragms IUD Permanent sterilization
Contraception
Thank you